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Lee N, Self-Brown SR, Bachman G, Howard AL, Gilbert LK, Hegle J, Perry EW, Saul J, Behl I, Massetti GM. Orphanhood vulnerabilities for violence and HIV by education, sex, and orphan type among 18-24-year-old youth: findings from the 2018 Lesotho violence against children and youth survey. PSYCHOL HEALTH MED 2024; 29:655-669. [PMID: 37434351 PMCID: PMC10782587 DOI: 10.1080/13548506.2023.2235280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
HIV and violence among orphans are key measures of vulnerability in low-resource settings. Although Lesotho has the second highest HIV adult prevalence rate (21.1%) in the world, and the prevalence of orphanhood (44.2%) and violence exposure (67.0%) is high, little research exist on orphanhood vulnerabilities for violence and HIV in Lesotho. Using data from 4,408 youth (18-24 years old) from Lesotho's 2018 Violence Against Children and Youth survey, a nationally representative cross-sectional household survey, the study examined associations among orphan status, violence, and HIV and assessed how associations differed by education, sex, and orphan type, using logistic regression. Orphans had higher odds of violence (aOR, 1.21; 95% CI, 1.01-1.46) and HIV (aOR, 1.69; 95% CI, 1.24-2.29). Having primary education or less (aOR, 1.43; 95% CI, 1.02-2.02), male sex (aOR, 1.74; 95% CI, 1.27-2.36), and being a paternal orphan (aOR, 1.43; 95% CI, 1.14-1.80) were significant interaction terms for violence. Orphans who completed primary school or less (aOR, 1.61; 95% CI, 1.09-2.39), female (aOR, 3.08; 95% CI, 2.14-4.42) and double orphans (aOR, 2.54; 95% CI, 1.56-4.13) had higher odds of HIV. These relationships highlight the importance of comprehensive strategies to support education and family strengthening for orphans as core violence and HIV prevention efforts.
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Affiliation(s)
- NaeHyung Lee
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
- Copial Business Strategists LLC, Atlanta, GA, USA
- Office of Strategy and Innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon R. Self-Brown
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Gretchen Bachman
- Office of Global HIV/AIDS, US Agency for International Development, Washington, DC, USA
| | - Ashleigh L. Howard
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leah K. Gilbert
- Office of Safety, Security, and Asset Management, Office of the Chief Operating Officer, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Hegle
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth W. Perry
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Janet Saul
- Office of the Global AIDS Coordinator and Health Diplomacy, US Department of State, Washington, DC, USA
| | - India Behl
- School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Greta M. Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Langwenya N, Toska E, Stöckl H, Cluver L. Which groups are most affected by sexual violence? A disaggregated analysis by sex, age, and HIV-status of adolescents living in South Africa. CHILD ABUSE & NEGLECT 2022:105981. [PMID: 36473807 DOI: 10.1016/j.chiabu.2022.105981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/08/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Estimates on sexual violence (SV) among adolescents are rarely disaggregated by key indicators. OBJECTIVE We examine the independent effects of sex, age, HIV status and mode of HIV acquisition on the exposure to SV using generalised estimating equations models and proportional hazard model. PARTICIPANT AND SETTING Data from a 4-year prospective cohort study of 1447 adolescents (ages 10-19, 57% girls, 76% living with HIV) in South Africa. METHODS We describe the lifetime prevalence of three forms of SV: non-contact (unwanted showing of private parts), contact (coerced sexual debut, attempted and completed forced penetrative or oral sex,) and exploitative (sex in exchange for goods/money). RESULTS Overall, 23.9% (95%CI = 21.7%-26.1%) reported exposure to SV at some point in their lives: non-contact = 5.7%, contact = 9.0% and exploitative = 15.8%. While girls reported higher rates of exploitative (18.4% vs 12.3%; p < 0.001) and contact SV (12.3% vs 4.6%; p < 0.001), there were no differences in levels of non-contact SV by sex (6.5% vs 4.6%; p = 0.086). Exposure to any SV doubled in late adolescence (10-14 years = 7.0% vs ≥15 years = 31.7%; aIRR = 2.07; 95%CI = 1.82-2.37). Though level of SV were comparable between those living with HIV and those HIV-uninfected (22.9% vs 26.2%; p = 0.182), adolescents who recently acquired HIV were twice as likely to experience SV compared to adolescents who perinatally acquired HIV (42.3% vs 15.7%; aIRR = 2.03; 95%CI = 1.73-2.39). This association persisted when analysis was restricted to incidence SV during follow-up (aIRR = 1.53; 95%CI = 1.23-2.10). CONCLUSION Exposure to SV was high for both sexes, increased with age and more prevalent among adolescents who recently acquired HIV. SV prevention and response services must also be offered to boys and strengthened in HIV care services.
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Affiliation(s)
- Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Nuffield College, University of Oxford, Oxford, United Kingdom.
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Centre for Social Science Research, University of Cape Town, Cape Town, South Africa; Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Shamu S, Shamu P, Zarowsky C, Temmerman M, Shefer T, Abrahams N. Does a history of sexual and physical childhood abuse contribute to HIV infection risk in adulthood? A study among post-natal women in Harare, Zimbabwe. PLoS One 2019; 14:e0198866. [PMID: 30608938 PMCID: PMC6319705 DOI: 10.1371/journal.pone.0198866] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/14/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Sexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women. METHODS A cross sectional survey was conducted among 2042 postnatal women (mean age = 26y) attending six public primary health care clinics in Harare, Zimbabwe within 6 weeks post-delivery. Clinic records were reviewed for mother's antenatal HIV status. Participants were interviewed about childhood abuse including physical or sexual abuse before 15 years of age, forced first sex before 16, HIV risk factors such as age difference at first sex before age 16. Multivariate analyses assessed the associations between mother's HIV status and child physical and sexual abuse while controlling for confounding variables. RESULTS More than one in four (26.6%) reported abuse before the age of 15: 14.6% physical abuse and 9.1% sexual abuse,14.3% reported forced first sex and 9.0% first sex before 16 with someone 5+ years older. Fifteen percent of women tested HIV positive during the recent antenatal care visit. In multivariate analysis, childhood physical abuse (aOR 3.30 95%CI 1.58-6.90), sexual abuse (3.18 95%CI: 1.64-6.19), forced first sex (aOR 1.42, 95%CI: 1.00-2.02), and 5+ years age difference with first sex partner (aOR 1.66 95%CI 1.09-2.53) were independently associated with HIV infection. CONCLUSION This study highlights that child physical and/or sexual abuse may increase risk for HIV acquisition. Further research is needed to assess the pathways to HIV acquisition from childhood to adulthood. Prevention of child abuse must form part of the HIV prevention agenda in Sub-Saharan Africa.
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Affiliation(s)
- Simukai Shamu
- Health Systems Strengthening Division, Foundation for Professional Development, Pretoria, South Africa
- School of Public Health, University of the Western Cape, Belville, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Patience Shamu
- Wits Reproductive Health Research Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Zarowsky
- School of Public Health, University of the Western Cape, Belville, South Africa
- University of Montreal Hospital Research Centre, Montreal, Canada
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- Obstetrics and Gynaecology, Agha Khan University, Nairobi, Kenya
| | - Tamara Shefer
- Department of Women and Gender Studies, University of the Western Cape, Belville, South Africa
| | - Naeemah Abrahams
- School of Public Health, University of the Western Cape, Belville, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
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Kidman R, Nachman S, Dietrich J, Liberty A, Violari A. Childhood adversity increases the risk of onward transmission from perinatal HIV-infected adolescents and youth in South Africa. CHILD ABUSE & NEGLECT 2018; 79:98-106. [PMID: 29428881 PMCID: PMC5878998 DOI: 10.1016/j.chiabu.2018.01.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/23/2018] [Accepted: 01/30/2018] [Indexed: 05/12/2023]
Abstract
Repeated exposure to childhood adversity (abuse, neglect and other traumas experienced before age 18) can have lifelong impacts on health. For HIV-infected adolescents and youth, such impacts may include onward transmission of HIV. To evaluate this possibility, the current study measured the burden of childhood adversity and its influence on risky health behaviors among perinatally-infected adolescents and youth. We surveyed 250 perinatally-infected adolescents and youth (13-24 years) receiving care in Soweto, South Africa. Both male and female participants reported on childhood adversity (using the ACE-IQ), sexual behavior, and psychosocial state. Viral load was also abstracted from their charts. We used logistic regressions to test the association between cumulative adversity and behavioral outcomes. Half the sample reported eight or more adversities. Overall, 72% experienced emotional abuse, 59% experienced physical abuse, 34% experienced sexual abuse, 82% witnessed domestic violence, and 91% saw someone being attacked in their community. A clear gradient emerged between cumulative adversities and behavioral risk. Having experienced one additional childhood adversity raised the odds of risky sexual behavior by almost 30% (OR 1.27, 95% CI 1.09-1.48). Viral suppression was poor overall (31% had viral loads >400 copies/ml), but was not related to adversity. Adversity showed a robust relationship to depression and substance abuse. Childhood adversity is common, influences the current health of HIV-positive adolescents and youth, and puts their sexual partners at risk for HIV infection. Greater primary prevention of childhood adversity and increased access to support services (e.g., mental health) could reduce risk taking among HIV-positive adolescents and youth.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population & Preventative Medicine, Stony Brook University, Health Sciences Center, Level 3, Stony Brook, NY, 11794, USA.
| | - Sharon Nachman
- Department of Pediatrics, Stony Brook School of Medicine, Stony Brook, NY, USA
| | - Janan Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Meinck F, Fry D, Ginindza C, Wazny K, Elizalde A, Spreckelsen TF, Maternowska MC, Dunne MP. Emotional abuse of girls in Swaziland: prevalence, perpetrators, risk and protective factors and health outcomes. J Glob Health 2018; 7:010410. [PMID: 28607670 PMCID: PMC5460395 DOI: 10.7189/jogh.07.010410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Research on emotional child abuse in sub–Saharan Africa is scarce. Few studies thus far have examined prevalence, risk and protective factors for emotional child abuse or the associations between emotional abuse and girls’ health. Methods A nationally representative two–stage, cluster–sampled, household survey of females aged 13–24 years (n = 1244) on childhood abuse victimisation was conducted. Participants completed interviewer–assisted questionnaires. Associations between emotional abuse and putative risk, and protective factors and health outcomes were analyzed using separate logistic regression models accounting for sampling design. Marginal effects of cumulative risk factors for emotional abuse victimisation were examined. Results Lifetime prevalence of emotional abuse was 28.5% with 58.3% of these girls reporting many abusive incidents. The most common perpetrators were female (27.8%) and male (16.7%) relatives and, more rarely, biological parents. Risk factors associated with emotional abuse were frequent caregiver changes (odds ratio (OR) 1.42, 95% confidence interval (CI) 1.03–1.970, poverty (OR 1.51, 95% CI 1.12–2.03), and physical abuse (OR 1.98, 95% CI 1.45–2.71) and sexual abuse (OR 2.22, 95% CI 1.57–3.10) victimisation. Being close to one’s mother was a protective factor (OR 0.88, 95% CI 0.80–0.97). Risk for emotional abuse increased from 13% with no risk factors present to 58.4% –with all four risk factors present. Health outcomes associated with emotional child abuse were suicidal ideation (OR 1.85, 95% CI 1.30–2.63) and feeling depressed (OR 1.89, 95% CI 1.31–2.71). Conclusions Girls in Swaziland experience high levels of emotional abuse victimisation. Emotional abuse is associated with economic disadvantage, family factors, other types of abuse victimisation and poor mental health. Therefore, a holistic approach to prevention is needed, incorporating poverty reduction and programmes to improve parent–child relationships, reduce the use of harsh criticism, and change parenting social norms.
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Affiliation(s)
- Franziska Meinck
- University of Oxford, Oxford, England, UK.,OPTENTIA, School of Behavioural Sciences, North-West University, Vanderbijlpark, South Africa
| | - Deborah Fry
- Moray House School of Education, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Kerri Wazny
- Moray House School of Education, University of Edinburgh, Edinburgh, Scotland, UK
| | - Aldo Elizalde
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | | | | | - Michael P Dunne
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Tapesana S, Chirundu D, Shambira G, Gombe NT, Juru TP, Mufuta T. Clinical care given to victims of sexual assault at Kadoma General Hospital, Zimbabwe: a secondary data analysis, 2016. BMC Infect Dis 2017; 17:602. [PMID: 28859613 PMCID: PMC5580318 DOI: 10.1186/s12879-017-2702-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/22/2017] [Indexed: 11/22/2022] Open
Abstract
Background Despite the guidelines for managing sexual assault being in place, victims of sexual assault attended to at Kadoma General Hospital consistently raised complaints related to the quality of care offered. Medicolegal data for sexual assault has been collected at the hospital since 2012. However, no analysis had been done regardless of complaints having been raised. We analysed the dataset to determine the quality of clinical care offered to sexual assault victims. Methods A retrospective cross-sectional study based on secondary data was conducted. Epi. Info 7 software was used to analyse data and generate frequencies, measures of central tendency and proportions. Results We analysed 474 medical affidavits completed between January 2014 and July 2016. Thirty percent of the victims sought care within 72 h of the sexual assault. Baseline HIV testing was done in 23 (22%) and follow-up HIV test done in 2 (2%) of the victims. Post Exposure Prophylaxis for HIV was administered to 18 (51%), emergency contraception 9 (69%) and forensic evidence gathered in six (5%) of victims presenting within the prescribed 72 h of the sexual assault. Prophylactic antibiotics were given to 156 (33%). There were no documented counselling sessions for all victims whilst follow up care was given to 47 (10%) victims. Conclusion Suboptimal clinical care was given to victims of sexual assault during the period 2014-2016. These findings suggest possible delayed presentation by victims of sexual assault as well as suboptimal administration of prophylaxis by health care workers. We recommend adherence to guidelines in managing sexual assault. Further research to determine factors for delayed presentation among sexual assault victims and quality of care provided to them is recommended.
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Affiliation(s)
- Stanley Tapesana
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | - Gerald Shambira
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Tshimanga Mufuta
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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Adjorlolo S, Adu-Poku S, Andoh-Arthur J, Botchway I, Mlyakado BP. Demographic factors, childhood maltreatment and psychological functioning among university students' in Ghana: A retrospective study. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2015; 52 Suppl 1:9-17. [DOI: 10.1002/ijop.12248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/12/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Samuel Adjorlolo
- Department of Applied Social Sciences; City University of Hong Kong; Kowloon Hong Kong
| | - Sarah Adu-Poku
- Department of Sociology; University of Ghana; Accra Ghana
| | - Johnny Andoh-Arthur
- Faculty of Health and Social Science; Sør-Trondelag University College; Trondheim Norway
- Department of Psychology; University of Ghana; Accra Ghana
| | - Irene Botchway
- Department of Psychology; University of Ghana; Accra Ghana
| | - Budeba Petro Mlyakado
- Department of Applied Social Sciences; City University of Hong Kong; Kowloon Hong Kong
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Rumble L, Mungate T, Chigiji H, Salama P, Nolan A, Sammon E, Muwoni L. Childhood sexual violence in Zimbabwe: evidence for the epidemic against girls. CHILD ABUSE & NEGLECT 2015; 46:60-66. [PMID: 25986577 DOI: 10.1016/j.chiabu.2015.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/16/2015] [Accepted: 04/27/2015] [Indexed: 06/04/2023]
Abstract
Sexual abuse during childhood is a public health and human rights concern throughout the world, including Sub-Saharan Africa. In 2011, Zimbabwe initiated national prevalence data collection on violence against children to inform government policy and programs. We interviewed 567 females and 589 males, aged 18-24 years following standardized and previously tested survey methods from the region. Of females 32.5%, and of males 8.9%, reported experiencing sexual violence before age 18. Most female (62.7%) and male (47.9%) victims of sexual violence experienced more than one incident of sexual violence prior to age 18 years. Three in four females (77.7%) and one in four males (26.7%) of those who experienced sexual violence reported that the first incident was perpetrated by a boyfriend or girlfriend. Few victims received professional help (2.7% of females and 2.4% of males who had reported experiencing sexual violence). Violence against girls is at epidemic levels in Zimbabwe. Most sexual violence against girls occurs within the context of peer relationships. Child victims who seek potentially life-saving support tend not to receive it. This study is evidence of a national public health and child rights emergency in the country and a case for increased, longer-term investment by the government and its development partners in policy reform for enhancing adolescent girls' empowerment and protection.
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Affiliation(s)
- Lauren Rumble
- United Nations Children's Fund (UNICEF) Indonesia, Wisma Metropolitan II, 11th Floor, Jl. Jend. SudirmanKav. 31, Jakarta 12920, Indonesia
| | - Taizivei Mungate
- Zimbabwe National Statistics Agency (ZIMSTAT), 20th Floor, Kaguvi Building, Cnr 4th Central Avenue, Harare, Zimbabwe
| | - Handrick Chigiji
- Zimbabwe National Statistics Agency (ZIMSTAT), 20th Floor, Kaguvi Building, Cnr 4th Central Avenue, Harare, Zimbabwe
| | - Peter Salama
- United Nations Children's Fund (UNICEF), Ethiopia, P.O. Box 1169, Africa Hall, Addis Ababa, Ethiopia
| | - Anthony Nolan
- United Nations Children's Fund (UNICEF) Sudan, UNICEF Totto Chan Compound, P.O. Box 45, Juba, South Sudan
| | - Elayn Sammon
- UNICEF Mozambique, 1440 Zimbabwe Avenue, Maputo, Mozambique
| | - Leon Muwoni
- Child Protection Specialist, UNICEF Zimbabwe, 6 Fairbridge Avenue, Belgravia, Zimbabwe
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Meinck F, Cluver LD, Boyes ME, Mhlongo EL. Risk and protective factors for physical and sexual abuse of children and adolescents in Africa: a review and implications for practice. TRAUMA, VIOLENCE & ABUSE 2015; 16:81-107. [PMID: 24648489 DOI: 10.1177/1524838014523336] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
There is now conclusive evidence of the major and long-lasting negative effects of physical and sexual abuse on children. Within Africa, studies consistently report high rates of child abuse, with prevalence as high as 64%. However, to date, there has been no review of factors associated with physical and sexual child abuse and polyvictimization in Africa. This review identified 23 quantitative studies, all of which showed high levels of child abuse in varying samples of children and adults. Although studies were very heterogeneous, a range of correlates of abuse at different levels of the Model of Ecologic Development were identified. These included community-level factors (exposure to bullying, sexual violence, and rural/urban location), household-level factors (poverty, household violence, and non-nuclear family), caregiver-level factors (caregiver illness in particular AIDS and mental health problems, caregiver changes, family functioning, parenting, caregiver-child relationship, and substance abuse), and child-level factors (age, disability, physical health, behavior, and gender). These findings identify key associated factors that are potential foci of child abuse prevention interventions. In addition, there is a clear need for further rigorous longitudinal research into predictive factors and culturally relevant interventions.
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Affiliation(s)
- Franziska Meinck
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford Barnett House, Oxford, UK Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Lucie D Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford Barnett House, Oxford, UK Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark E Boyes
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford Barnett House, Oxford, UK School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Elsinah L Mhlongo
- Office on the Rights of the Child, Office of the Premier, Mpumalanga Provincial Government, Mpumalanga, South Africa
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Gender (in) differences in prevalence and incidence of traumatic experiences among orphaned and separated children living in five low- and middle-income countries. Glob Ment Health (Camb) 2015; 2:e3. [PMID: 26085939 PMCID: PMC4467827 DOI: 10.1017/gmh.2015.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Approximately 153 million children worldwide are orphaned and vulnerable to potentially traumatic events (PTEs). Gender differences in PTEs in low- and middle-income countries (LMIC) are not well-understood, although support services and prevention programs often primarily involve girls. METHODS The Positive Outcomes for Orphans study used a two-stage, cluster-randomized sampling design to identify 2837 orphaned and separated children (OSC) in five LMIC in sub-Saharan Africa and Asia. We examined self-reported prevalence and incidence of several PTE types, including physical and sexual abuse, among 2235 children who were ≥10 years at baseline or follow-up, with a focus on gender comparisons. RESULTS Lifetime prevalence by age 13 of any PTE other than loss of a parent was similar in both boys [91.7% (95% confidence interval (CI) (85.0-95.5)] and girls [90.3% CI (84.2-94.1)] in institutional-based care, and boys [92.0% (CI 89.0-94.2)] and girls [92.9% CI (89.8-95.1)] in family-based care; annual incidence was similarly comparable between institution dwelling boys [23.6% CI (19.1, -29.3)] and girls [23.6% CI (18.6, -30.0)], as well as between family-dwelling boys [30.7% CI (28.0, -33.6)] and girls [29.3% CI (26.8,-32.0)]. Physical and sexual abuse had the highest overall annual incidence of any trauma type for institution-based OSC [12.9% CI (9.6-17.4)] and family-based OSC [19.4% CI (14.5-26.1)], although estimates in each setting were no different between genders. CONCLUSION Prevalence and annual incidence of PTEs were high among OSC in general, but gender-specific estimates were comparable. Although support services and prevention programs are essential for female OSC, programs for male OSC are equally important.
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Morantz G, Cole DC, Ayaya S, Ayuku D, Braitstein P. Maltreatment experiences and associated factors prior to admission to residential care: a sample of institutionalized children and youth in western Kenya. CHILD ABUSE & NEGLECT 2013; 37:778-87. [PMID: 23290620 PMCID: PMC3633719 DOI: 10.1016/j.chiabu.2012.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/15/2012] [Accepted: 10/18/2012] [Indexed: 05/14/2023]
Abstract
OBJECTIVES This study aims to determine the prevalence of maltreatment experienced by institutionalized children prior to their admission to Charitable Children's Institutions (orphanages) in western Kenya, and to describe their socio-demographic characteristics, reasons for admission, and the factors associated with prior experiences of maltreatment. METHODS A systematic file review was undertaken in five CCIs. Demographic, prior caregiving settings and maltreatment data were extracted. Forms of maltreatment were recorded according to WHO and ISPCAN guidelines. Logistic regression was used in bivariate and multivariable analyses of factors associated with reasons for placement and forms of maltreatment. RESULTS A total of 462 files were reviewed. The median (interquartile range) age of children was 6.8 (5.08) years at admission, 56% were male, and 71% had lost one or both parents. The reasons for admission were destitution (36%), abandonment (22%), neglect (21%), physical/sexual abuse (8%), and lack of caregiver (8%). The majority of child and youth residents had experienced at least one form of maltreatment (66%): physical abuse (8%), sexual abuse (2%), psychological abuse (28%), neglect (26%), medical neglect (18%), school deprivation (38%), abandonment (30%), and child labor (23%). The most common reason for non-orphans to be admitted was maltreatment (90%), whereas the most common reason for orphans to be admitted was destitution (49%). Girls (adjusted odds ratio, AOR: .61, 95% CI: .39-.95) and orphans (AOR: .04, 95% CI: .01-.17) were both independently less likely to have a history of maltreatment irrespective of whether it was the reason for admission. Children whose primary caregiver had not been a parent (AOR: .36, 95% CI: .15-.86) and orphans (AOR: .17, 95% CI: .06-.44) were less likely to have been admitted for maltreatment, while children who were separated from siblings were more likely to have been admitted for maltreatment (AOR: 1.62, 95% CI: 1.01-2.60). CONCLUSIONS The high prevalence of maltreatment prior to admission, particularly among nonorphans, suggests the need for better child abuse and neglect prevention programs in communities, and psychosocial support services in institutions. The significant proportion of children admitted for poverty, predominantly among orphans, indicates that community-based poverty-reduction programs might reduce the need for institutionalization.
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Affiliation(s)
- Gillian Morantz
- Department of General Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Donald C. Cole
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Science Building, 6th floor, Toronto, Toronto, Ontario, Canada M5T 3M7
| | - Samuel Ayaya
- Moi University School of Medicine, P.O Box 4606, 030100, Eldoret, Kenya
| | - David Ayuku
- Moi University School of Medicine, P.O Box 4606, 030100, Eldoret, Kenya
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Science Building, 6th floor, Toronto, Toronto, Ontario, Canada M5T 3M7
- Moi University School of Medicine, P.O Box 4606, 030100, Eldoret, Kenya
- Indiana University School of Medicine, 1120 South Drive, Fesler Hall, Indianapolis, Indiana, 46202-5114, United States
- United States Agency for International Development-Academic Model Providing Access to Healthcare (AMPATH) Partnership, P.O. Box 4606, 030100, Eldoret, Kenya
- Regenstrief Institute Inc., 1050 Wishard Boulevard, 6th Floor, Indianapolis, Indiana, 46202-2872, United States
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